GUIDANCE FOR MANAGERS WHEN CARRYING OUT RISK ASSESSMENTS FOR
HEALTHCARE WORKERS
The following guidance is based upon a European Communication issued
20/11/2000, which can be found in its entirety on the HSE website and is available
through a link from the Occupational Health website. Guidance is also taken from
the Association of NHS Occupational Health Physicians.
Generic hazards
Mental and physical
fatigue and working
hours
Postural problems
connected with the
activities of new or
expectant mothers
Preventative or risk control measures
It may be necessary to adjust working hours temporarily, as
well as the timing and frequency of rest breaks, and to
change shift patterns.
Expectant mothers can still work night shifts unless there is a
specific identified risk. In this instance the employee must
provide a medical certificate from their doctor or midwife
stating that they must not work nights. Occupational Health
may also have identified that night work could impact on the
individuals health and safety.
If this is the case then the employee must be offered suitable
alternative daytime work. If this is not possible, the employee
must be suspended form work on paid leave for as long as
necessary to protect their and the health and safety of their
child.
Ensure that the hours, volume and pacing of work are not
excessive and that, where possible, the employee has some
control over how work is organised. Fatigue can be
addressed with longer and more frequent breaks.
Extremes of heat or
cold
Work in a high
pressure
atmosphere, for
example pressurised
enclosures
Pregnant workers should not be exposed to prolonged
excessive heat or cold at work
Pregnant workers should not work in high-pressure
atmospheres.
Display screen
equipment use
In the light of the scientific evidence, pregnant women do not
need to stop working with VDUs. However, to avoid
problems caused by stress and anxiety, women who are
pregnant and are worried about working with VDUs should
be given the opportunity to discuss their concerns with
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Generic hazards
Work at heights
Working alone
Occupational stress
Standing activities
Manual Handling
Preventative or risk control measures
someone adequately informed of current authoritative
scientific information and advice.
The employer must ensure that pregnant workers do not
work at heights (e.g. ladders and scaffolds)
Depending on their medical condition, help and support
needs to be available when required and emergency
procedures (if needed) must take into account factors
affecting the pregnant women.
Employers will need to take account of known stress factors
(‘stressors’) (such as shift pattern, job security, workloads,
etc.) and the particular factors affecting pregnant women. If
significant stressors are identified a stress risk assessment
should be carried out. Further information available on from
the Occupational Health department
Physiological changes during pregnancy (increased blood and
systolic volume, general dilatation of blood vessels and
possible compression of abdominal or pelvic veins) promote
peripheral congestion while standing. Venous compression
may reduce the venous return from the pelvis which leads to
compensatory increases in the maternal heart rate and to
contractions of the uterus. If the compensation is insufficient,
this may lead to dizziness and faintness. Continuous standing
(and/or walking) for long periods during the working day also
contributes to an increased risk of premature childbirth
Ensure that seating is available where appropriate. Constant
sitting or constant standing is both inadvisable. It is better to
alternate between the two. If this is not possible, provision
should be made for breaks.
Manual handling of heavy loads is considered to pose a risk
to pregnancy, such as risk of foetal injury and premature
birth. The risk depends on strain, i.e. the weight of the load,
how you lift and how often it occurs during work time. As the
pregnancy progresses, a pregnant worker is at greater risk
from manual handling injury. This is due to hormonal
relaxation of the ligaments and the postural problems of
advancing pregnancy. There can also be risks for those who
have recently given birth, for example after a Caesarean
section there is likely to be a temporary limitation on lifting
and handling capability. Breastfeeding mothers may
experience discomfort due to increased breast size and
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Generic hazards
Preventative or risk control measures
sensitivity.
The changes an employer should make will depend on the
risks identified in the assessment and the circumstances of
the business. For example, it may be possible to alter the
nature of the task so that risks from manual handling are
reduced for all workers, including new or expectant mothers.
Or it may be necessary to address the specific needs of the
worker and reduce the amount of physical work, or provide
aids for her in future to reduce the risks she faces.
Lack of rest and
Provide access to somewhere where the employee can sit or
other welfare issues lie down comfortably in private and without disturbance, at
(includes passive
appropriate intervals. Expectant mothers must be warned of
smoking
any risk from passive smoking.
Risk of kidney
Working practices need to be adapted, for example, in
disease (lack of toilet continuous processing and team working situations,
facilities)
Appropriate measures must enable expectant and nursing
mothers to leave their workstation/activity short notice, and
more frequently than normal.
Hazards as a result
New and expectant mothers’ particular needs concerning
of inappropriate
rest, meal and refreshment breaks may be established in
nutrition
consultation with the individual.
Unsuitable or absent Protective measures must include:
facilities regarding
-access to a private room in which to breastfeed or express
pregnancy
breast milk.
-use of secure, clean refrigerators for storing expressed
breast milk whilst at work, and facilities for washing,
sterilising and storing receptacles.
-time off (without penalty) to express milk or breastfeed.
Noise
The employer must ensure that workers who are pregnant,
who have recently given birth or who are breastfeeding, are
not exposed to noise levels exceeding national exposure limit
values: 85 dB(A)
Vibration(includes
Excessive vibration should be avoided. It should be
whole body
recognised that use of personal protective equipment by the
vibration)
mother will not protect the unborn child from a vibration
hazard.
Traveling either
Traveling in the course of work, and to and from the
inside or outside the workplace, can be problematic for pregnant women,
establishment or on involving risks including fatigue, vibration, stress, static
business
posture, discomfort and accidents. These risks can have a
significant effect on the health of new and expectant
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Generic hazards
Ionising radiation
Antimitotic
(cytotoxic)
Drugs In the long
term these drugs
cause damage to
genetic information
in sperm and eggs.
Some can cause
cancer. Absorption is
by inhalation or
through the skin.
Assessment of the
risk should look
particularly
at preparation of the
drug for use
(pharmacists,
nurses),
administration of the
drug and disposal of
waste (chemical and
human).
Mercury and
mercury
Derivatives Organic
Preventative or risk control measures
mothers.
Where travel for business is required advice should be taken
from Occupational health and the women’s health care
providers with regard to flying, vaccinations and prophylactic
treatments.
As soon as a pregnant woman informs the organisation of her
condition, the protection of the unborn child must be
comparable with that provided for members of the public.
The equivalent dose to the unborn child has to be as low as
reasonable achievable, and will not usually exceed 1mSv
during at least the remainder of the pregnancy.
Special attention should be paid to the possibility of nursing
mothers encountering radioactive contamination and they
should not be employed where there is a significant risk of
such contamination.
There is no known threshold limit and exposure must be
avoided or reduced. Those trying to conceive a child or who
are pregnant or breastfeeding should be fully informed of the
reproductive hazard. When preparing the drug solutions,
exposure should be minimised by the use of protective
garments (gloves, gowns and mask), equipment (flow hood),
and good working practices.
A pregnant worker preparing antineoplastic drug solutions
should be transferred to other work.
Prevention of exposure must be the first priority. Where it is
not appropriate to prevent the risk, control of exposure may
be by a combination of technical measures, along with good
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Generic hazards
mercury compounds
could have adverse
effects on the
unborn child. Animal
studies and human
observations have
demonstrated that
exposure to these
forms of mercury
during pregnancy
can slow the growth
of the unborn baby,
disrupt the nervous
system, and cause
the mother to be
poisoned.
Organic mercury is
transferred from
blood to milk. That
may pose a risk to
offspring, if a
woman is highly
exposed before and
during pregnancy.
Anaesthetic gases
The evidence for an
association between
exposure to
anaesthetic
gases and adverse
pregnancy outcomes
is weak and largely
based on data
published prior to
the introduction of
more effective
scavenging systems
and the increased
use of intravenous
and local
Analgesia.
Preventative or risk control measures
work planning and housekeeping, and the use of Personal
Protective Equipment (PPE). PPE should only be used for
control purposes if all other methods have failed. It may also
be used as secondary protection in combination with other
methods.
Assessment should be based on what is known about the
adequacy of scavenging systems and the anaesthetic
exposure levels. Special consideration may be needed in staff
who are known to have a relatively poor obstetric history. It
may be necessary to consider modification of work.
Alternative safe tasks or paid leave may need to be
considered and are more relevant in the first trimester of
pregnancy where the aim is to achieve as low a risk as
possible of spontaneous abortion. Control of risk may be
achieved by reducing gas inductions, patient turnover and
increasing employee’s distance from the source. Work should
be in well ventilated areas.
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Generic hazards
Chemicals and
Substances.
Does work involve
contact with
chemicals
labelled as:R23, R24, R26, R27,
R28: Toxic
R33: Danger of
Cumulative effects.
R39: Serious
irreversible effects.
R40: Limited
evidence
but may cause
Carcinogenic effect.
R45, R49: May cause
Cancer.
R46: May cause
heritable genetic
Damage.
R48: May cause
damage to health by
prolonged exposure.
R60, R62: Possible
risk of impaired
infertility.
R61, R63: May cause
harm to the unborn
child.
R64: May cause
harm in breast
feeding.
R68: Possible risk of
Irreversible effects.
Biological Agents
Many biological
agents
can affect the
Preventative or risk control measures
ALL chemicals and substances should be immediately risk
assessed against COSHH regulations. COSHH assessments
should already be in place if these substances are being used
on the trust premises.
The actual risk to health of these substances can only be
determined following a risk assessment of a particular
substance at the place of work - i.e. although the substances
listed may have the potential to endanger health or safety,
there may be no risk in practice, for example if exposure is
below a level which might cause harm.
For work with hazardous substances, which include chemicals
which may cause heritable genetic damage, employers are
required to assess the health risks to workers arising from
such work, and where appropriate prevent or control the
risks. In carrying out assessments, employers should have
regard for women who are pregnant, who have recently
given birth or who are breast feeding.
Prevention of exposure must be the first priority. Where it is
not appropriate to prevent the risk, control of exposure may
be by a combination of technical measures, along with good
work planning and housekeeping, and the use of Personal
Protective Equipment (PPE). PPE should only be used for
control purposes if all other methods have failed. It may also
be used as secondary protection in combination with other
methods.
Substitution of harmful agents should be made, if possible.
Remember that exposure may occur through skin
absorption, ingestion, or most commonly, through
inhalation of chemical aerosols.
If the new of expectant of breastfeeding mother is or is
potentially exposed to any of the substances listed, please
contact Occupational Health immediately for advice.
Risk assessment, which will take account firstly of the nature
of the biological agent, how infection is spread, how likely
contact is, and what control measures there are. These
include physical containment and the usual hygiene
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Generic hazards
unborn
child if the mother is
infected during
pregnancy. These
may be transmitted
through the placenta
while the child is in
the womb, or
during or after birth,
for example through
breastfeeding or
through close
physical contact
between mother
and child.
Examples of agents
where the child
might be infected in
one of these ways
are Hepatitis, HIV,
Herpes, TB, Syphilis,
Rubella/Measles,
Chickenpox, Mumps,
Listeria,
Toxoplasmosis,
Typhoid, Parvovirus,
Cytomegalovirus
For most workers,
the risk of infection
is not higher at work
than from living in
the community; but
in certain
occupations,
exposure to
infections are more
likely.
The chance of
catching these
infections can be
minimised by using
Preventative or risk control measures
measures. The use of available vaccines is to be
recommended, with due regard for any contra-indications for
administering certain of them to women in the early stages
of pregnancy. If there is a known high risk of exposure to a
highly infectious agent, then it will be appropriate for the
pregnant worker to avoid exposure altogether. The employer
must ensure immunity testing for risk occupations, and job
transfer or temporary leave during epidemics.
Pregnant and breast feeding members of staff should avoid
contact with the listed hazards. This includes contact with
potentially infected people or biological samples. They must
also avoid any undiagnosed rash compatible with systemic
viral illness. If such contact occurs the individual should
contact the Occupational Health Department/GP/Midwife for
advice immediately.
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Generic hazards
normal hygienic
precautions,
especially
hand washing after
patient contact
Preventative or risk control measures
Aspects of pregnancy which may require adjustments to work organisation
Apart from the hazards listed in the table, there are other aspects of pregnancy that
may affect work. The impact will vary during the course of the pregnancy and their
effect should be kept under review; for example, the posture of expectant mothers
changes to cope with increasing size.
Aspects of pregnancy Factors in work
Morning sickness
Early shift work Exposure to strong or nauseating
smells/poor ventilation
Travel/transport
Backache Standing/manual handling/posture varicose
veins/other circulatory problems/haemorrhoids, prolonged
standing/sitting
Rest and welfare
Frequent/urgent visits to toilet
Regular nutrition
Proximity/availability of rest/washing/eating/drinking
facilities
Hygiene
Difficulty in leaving job/work site
Comfort
Increasing size, Use of protective clothing/ work equipment,
Work in confined areas/at heights Dexterity, agility, coordination, speed of movement, reach may be impaired,
because of increasing size
Postural demands e.g. bending over, reaching
Manual handling
Problems of working in restricted spaces
Fatigue/stress
Fatigue/stress: Overtime, Evening/night work, Lack of rest
breaks, Excessive hours, Pace/intensity of work
Balance
(also relevant for breastfeeding mothers) Problems of
working on slippery, wet surfaces
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Date issued: December 2015
CORP EMP 15 v10 Parental Leave Policy
RISK ASSESSMENT FOR EXPECTANT AND NEW MOTHERS
Name
Job Title
HAZARD
BIOLOGICAL AGENTS
Biological Hazard group 2, 3 & 4
PHYSICAL AGENTS
Shocks, vibration, movement
Manual handling
Personal protective equipment and
clothing
Excessive Noise
Ironising radiation
Non Ionising electro-magnetic
radiation
Extremes of cold or heat
Physical fatigue
Mental fatigue and stress
Violence / aggression
Working at height
Excessive working hours (Overtime)
Night Working
Standing for long periods
Driving/travelling
CHEMICAL AGENTS
Substances labelled R40, R45, R49,
R60, R61, R63& R64, R68 under
COSHH Regulations
Mercury & Derivatives
Cytotoxic Drugs
Chemicals absorbed through the skin
Carbon Monoxide
Lead and derivatives
Cigarette smoke
WORKING CONDITIONS
Manager
Date notified of pregnancy
PRESENT
CONTROLS IN PLACE
ADEQUATE
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
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FURTHER ACTION REQUIRED
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CORP EMP 15 v10 Parental Leave Policy
HAZARD
PRESENT
Ergonomics/Posture
Yes/No
Work Space
Yes/No
Working at height
Yes/No
Display screen equipment
Yes/No
Adequate facilities for rest/breaks
Yes/No
OTHER HAZARD NOT LISTED
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
REVIEW DATES
REASON FOR REVIEW
CONTROLS IN PLACE
ADEQUATE
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
FURTHER ACTION REQUIRED
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
CONCLUSION
SIGNATURE OF MANAGER
SIGNAGURE OF EMPLOYEE
Please Note:
Completion of this risk assessment is a legal requirement of the HSE. It should be completed on the first day of notification of pregnancy and every 12 weeks
thereafter or on request of the employee. (The Management of Health and Safety at Work Regulations 1999)
If an employees work or health changes then a new risk assessment must be carried out
If an employee presents a medical certificate stating they are unable to carry out particular duties, this must be brought to the immediate attention of the line
manager.
Assessment completed by...
Signature of Employee:…
Date…
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